Neue Entwicklungen in der medizinischen Mykologie

Not only have the systemic mycoses clearly increased in number but also mycoses of the skin are more common than presumed in the past. Today onychomycosis is found in up to 10% of human beings. Onychomycosis can compromise quality of life markedly. Common tinea pedis is one of the most important risk factors for erysipelas of the lower legs. The clinical presentation of oral candidosis in HIV-infected patients is changing; Candida dubliniensis has been identified as another important causative microorganism. Onychomycosis today in most cases can be cured using terbinafine or itraconazole. When choosing the ideal drug in a given case, both the benefit risk ratio and the benefit cost ratio have to be taken into account. Liposomally encapsulated amphotericin B represents a major breakthrough in the treatment of systemic mycoses or fever of unknown origin. The same applies to liposomally encapsulated econazole with respect to tinea pedis. In regard to the pathogenesis of Candida infections the family of secreted aspartic proteinases plays a major role as a virulence factor and possible future target for antimycotic treatment.     

Evaluation of in vitro activity of ciclopirox olamine,butenafine HCl and econazole nitrate against dermatophytes,yeasts and bacteria

Background In many instances, a cutaneous fungal infection may exist concomitantly with bacterial involvement. In this study we compared the in vitro activity of three antifungal agents against the dermatophytes, yeasts and bacteria recovered most commonly from cutaneous mycoses and bacterial infections. Methods Using a microdilution method adapted from the National Committee for Clinical Laboratory Standards (NCCLS), we determined the minimum inhibitory concentrations (MICs) of ciclopirox olamine, econazole nitrate and butenafine HCl against a panel of dermatophyte fungi and yeasts (n = 39) and bacterial isolates (n = 45). Results All three antifungals demonstrated comparable activity against the dermatophytes tested, with a MIC range of 0.03–0.25 µg/ml for ciclopirox, < 0.001–0.25 µg/ml for econazole and 0.03–0.25 µg/ml for butenafine. For yeasts, ciclopirox showed activity against all isolates, with an MIC range of 0.001–0.25 µg/ml, whereas econazole had a broader range of 0.125–> 0.5 µg/ml. Butenafine displayed limited activity against the yeast Candida albicans and no activity against Malassezia furfur. For the antibacterial activity studies, ciclopirox demonstrated activity against all isolates tested with a range of 0.06–2 µg/ml, while econazole showed activity against Gram‐positive bacteria only, with a MIC range of 0.004–0.25 µg/ml. Butenafine HCl had a limited activity against bacterial isolates tested, showing activity against β‐hemolytic Streptococcus Group A and Corynebacterium only. Neither econazole nitrate nor butenafine HCl demonstrated activity against any of the Gram‐negative strains evaluated in this study. Conclusions The data suggest that ciclopirox olamine has the broadest in vitro activity, in comparison to econazole and butenafine HCl, against bacteria, yeasts and bacteria. These findings may have implications in the use of these antimycotics in the treatment of mixed cutaneous infections where bacteria or yeasts are present in addition to dermatophytes.     

Contact allergy to imidazoles used as antimycotic agents

The present article reviews the literature (up to 1994) on contact sensitivity to imidazoles and presents the results obtained from 15 patients observed at the Contact Allergy Unit in Leuven. The frequency as well as the cross-reaction patterns described are analyzed. Although allergic contact reactions may have been missed in the past (mainly because of problems with the correct choice of vehicle for patch testing), they seem to be relatively infrequent in view of their widespread use. The imidazole derivatives most frequently reported 10 be allergens are miconazole, econazole, tiocanozole, and isoconazole. As far as cross-reactivity is concerned, statistically significant associations were found in the patient data between miconazole, econazole, and isoconazole: between isoconazole and miconazole and econazole: and also between isoconazole and tioconazole. Patients sensitive to phenylethyl imidazoles (except ketoconazole) needing antimycotic therapy should be advised to use ketoconazole, clotrimazole, bifonazole, or, perhaps, the new flutrimazole. Clearly, non-imidazole antifungals can also be used.     

Clotrimazole and econazole in the treatment of vaginal candidosis. A single-blind comparison

Clotrimazole and econazole used as treatment for vaginal candidosis are both effective when given for three days. In a single-blind controlled study of 110 women followed for 14 days the efficacy of treatment with clotrimazole and econazole for three days was equal. Eighty-six per cent of the group treated with clotrimazole were mycologically clear at 14 days compared with 90% of those treated with econazole. Both treatment regimens were equally acceptable to the patients and no side effects were reported.     

Clotrimazole and econazole in the treatment of vaginal candidosis. A single-blind comparison.

Clotrimazole and econazole used as treatment for vaginal candidosis are both effective when given for three days. In a single-blind controlled study of 110 women followed for 14 days the efficacy of treatment with clotrimazole and econazole for three days was equal. Eighty-six per cent of the group treated with clotrimazole were mycologically clear at 14 days compared with 90% of those treated with econazole. Both treatment regimens were equally acceptable to the patients and no side effects were reported.     

外喷中药制剂联合曲安奈德益康唑乳膏治疗念球菌性龟头炎效果的临床观察

目的：观察中药汤剂改颗粒剂外喷联合曲安奈德益康唑乳膏治疗念球菌性龟头炎的临床疗效。方法：135例患者随机分为治疗组和对照A组和对照B组,每组45例。治疗组给予中药基本方取颗粒剂兑成中药汤液,装入专用容器外喷,2次/d,联合曲安奈德益康唑乳膏外涂,2次/d。对照A组,基本方水煎外洗,2次/d,联合曲安奈德益康唑乳膏外涂,2次/d。对照B组,单独使用曲安奈德益康唑乳膏,2次/d,连用14d。结果：联合用药组治疗念珠菌性包皮龟头炎的方法无论在治疗1周与2周时临床有效率（痊愈＋显效）均高于单独使用曲安奈德益康唑乳膏组,两组真菌学疗效无差异。而中药外喷组与中药外洗组在疗效上无明显差异。结论：中药汤剂外洗改颗粒剂外喷联合曲安奈德益康唑乳膏外涂治疗念球菌性龟头炎安全有效,可行。     

The antibacterial efficacy of econazole nitrate in interdigital toe web infections

Twenty-four patients with severe interdigital toe web infections and no evidence of dermatophyte colonization received randomized treatment with either econazole nitrate (Spectazole) or its vehicle. Of the patients treated with econazole nitrate, 88% had good to excellent responses, whereas no patient treated with the vehicle showed improvement. The total aerobic flora in the econazole group decreased 93%, with decreases in the large-colony diphtheroids, lipophilic diphtheroids, and gram-negative bacteria. The results of this study demonstrate that the antibacterial activity of econazole nitrate makes it an effective agent for the treatment of severe interdigital bacterial infections uncomplicated by dermatophyte colonization.     

Treatment of vaginal candidosis with econazole nitrate and nystatin: A comparative study

A study carried out to compare the efficacy of econazole nitrate and nystatin in the treatment of vaginal candidosis showed that a three-day course of econazole nitrate pessaries was as effective as a 14-day course of nystatin pessaries and is more acceptable to patients.     

Comparison of econazole and isoconazole as single dose treatment for vaginal candidosis.

In a single blind trial there was no significant difference between econazole (2 X 150 mg pessaries) and isoconazole (2 X 300 mg pessaries) given as a once only treatment for vaginal candidosis. Cure rates at 14 days were 70.4% for econazole and 77.6% for isoconazole, and at 28 days were 63.8% and 64.5% respectively. Though isoconazole was formulated for single dose usage, econazole was formulated for a regimen of one pessary a night for three nights.     

The immune status of patients with foot mycosis and eczema

Thirty-five patients with squamous-hyperkeratotic mycoses and onychomycoses were examined, as were 68 ones with exudative mycoses of the soles and 97 ones with disseminated eczemas. The following tests have been employed in the study: direct and indirect leucocyte migration inhibition, investigation of the lymphocyte functional activity, skin test with fungal antigen, quantitation of the absolute counts of lymphocytes, neutrophils and phagocytizing neutrophils, T and B rosette forming cells. Patients with mycoses of the soles with involvement of the nail plates, as well as those suffering from eczemas combined with mycoses developed a most marked reduction of the activity of the leukocyte migration inhibition factor (LMIF) and of the T lymphocyte mediator activity in the presence of the fungal antigen. The studies have detected the pattern of the leukocyte phagocytic reaction disturbances in the patients with mycoses and eczemas of the soles. No inhibiting effect of LMIF on the leukocytes in these patients appears to be due to the defect of the target cells and not of the producer cells. The direct and indirect leukocyte migration inhibition tests are recommended to be included in the complex of immunologic tests used in examinations of patients with exudative mycoses and eczemas of the soles and with the transitional and combined forms of these two conditions.     

Chromoblastomycosis from a Non-endemic Area and Response to Itraconazole

Chromoblastomycosis belongs to the heterogeneous group of subcutaneous mycoses. It is caused by various pigmented (dematiaceous) fungi, which gain entry into the skin via traumatic implantation. We would like to share a case report of chromoblastomycosis in a 32-year-old male, who presented to us with 3 years history of slowly progressive, itchy, verrucous, crusted lesions over right forearm and arm. He is being treated with itraconazole 100 mg twice daily. The case is of interest because it has so far not been reported from our region- the northwest arid zone of India. The patient showed favorable response to itraconazole.     

强力脉痔灵联合曲安奈德益康唑乳膏治疗肛周湿疹疗效观察

目的观察强力脉痔灵联合曲安奈德益康唑乳膏治疗肛周湿疹的临床疗效。方法采用随机法将99例患者分为两组,治疗组50例,予强力脉痔灵2片口服,同时外用曲安奈德益康唑乳膏,均2次/d,连用3周。对照组49例,仅外用曲安奈德益康唑乳膏,连用3周。两组均治疗结束时观察近期疗效,痊愈者随访3个月观察远期疗效。结果治疗组近期疗效有效率80.00%,对照组为71.43%,差异无显著性(P>0.05);痊愈病例随访3个月,治疗组复发率20.0%,对照组57.9%,差异有显著性(P<0.01)。结论强力脉痔灵联合曲安奈德益康唑乳膏治疗肛周湿疹疗效好。     

银屑病皮损鳞屑中两种微生物的检测及外用派瑞松效果

目的探讨银屑病发病与金黄色葡萄球菌(简称金葡菌)、糠秕孢子菌感染的关系及观察外用派瑞松治疗效果。方法对银屑病病人皮损进行细菌培养及真菌真接镜检,并外用派瑞松治疗。结果银屑病患者金葡菌和糠秕孢子菌带菌率均高于正常对照(P<0.01;P<0.05),治疗后带菌率明显下降;治愈率和有效率分别为18.0%,72.0%。结论金葡菌、糠秕孢子菌在银屑病的发病和发展中起一定作用,派瑞松是治疗银屑病较好的药物之一。     

Blastomycosis presenting as solitary nodule: a rare presentation

Blastomycosis is a chronic granulomatous and suppurative mycosis, caused by Blastomyces dermatitidis, which in the great majority of cases presents as a primary pulmonary disease. Primary cutaneous blastomycosis is very rare. We present a 57-year-old female patient with a solitary, slowly progressive nodule over upper lip of 2½ months duration. Initially, differential diagnosis of cutaneous leishmaniasis, pyoderma and deep mycoses were entertained. Slit smear preparation was suspicious of deep mycotic infection which was subsequently confirmed by biopsy and culture.     

国产联苯苄唑（白呋唑）治疗皮肤真菌病的疗效观察

用联苯苄唑和益康唑等对照治疗皮肤真菌病９７例。治疗体股癣的痊愈率，联苯苄唑为８９．４７％，益康唑为８４％。虽然二者间无统计学差异（Ｐ＞０．０５），但联苯苄唑每日只需用药１次，方便、清洁，且无显著副作用。可作为外治皮肤真菌病的首选药物之一。     

曲安奈德益康唑乳膏长疗程间歇疗法治疗局限性慢性湿疹

目的 探讨外用糖皮质激素长疗程间歇疗法治疗局限性慢性湿疹的疗效、安全性及复发情况,以指导临床用药.方法 选取门诊局限性慢性湿疹患者,外用曲安奈德益康唑乳膏短程治疗.症状积分下降指数(SSRI)≥190%的患者进入长疗程,随机分两组,分别外用曲安奈德益康唑乳膏和润肤霜,间歇用药,共治疗8周.长疗程治疗4周、8周时及长疗程治疗停药12周时各随访1次.结果 长疗程治疗8周及停药12周时,曲安奈德益康唑组SCORAD评分均显著低于润肤霜组(t值分别为3.076和2.367,P值均<0.05).长疗程治疗4周、8周及停药12周时,曲安奈德益康唑组复发率均显著低于润肤霜组(x2值分别为4.426、7.683、8.199,P值均<0.05).治疗期间不良反应发生率3.1%,无严重不良事件.结论 外用糖皮质激素长疗程间歇治疗慢性湿疹,有防止症状加重、延缓湿疹复发的作用.     

曲安奈德益康唑乳膏长疗程间歇疗法治疗局限性慢性湿疹

目的 探讨外用糖皮质激素长疗程间歇疗法治疗局限性慢性湿疹的疗效、安全性及复发情况,以指导临床用药.方法 选取门诊局限性慢性湿疹患者,外用曲安奈德益康唑乳膏短程治疗.症状积分下降指数(SSRI)≥190%的患者进入长疗程,随机分两组,分别外用曲安奈德益康唑乳膏和润肤霜,间歇用药,共治疗8周.长疗程治疗4周、8周时及长疗程治疗停药12周时各随访1次.结果 长疗程治疗8周及停药12周时,曲安奈德益康唑组SCORAD评分均显著低于润肤霜组(t值分别为3.076和2.367,P值均<0.05).长疗程治疗4周、8周及停药12周时,曲安奈德益康唑组复发率均显著低于润肤霜组(x2值分别为4.426、7.683、8.199,P值均<0.05).治疗期间不良反应发生率3.1%,无严重不良事件.结论 外用糖皮质激素长疗程间歇治疗慢性湿疹,有防止症状加重、延缓湿疹复发的作用.     

曲安奈德益康唑乳膏长疗程间歇疗法治疗局限性慢性湿疹

目的 探讨外用糖皮质激素长疗程间歇疗法治疗局限性慢性湿疹的疗效、安全性及复发情况,以指导临床用药。方法 选取门诊局限性慢性湿疹患者,外用曲安奈德益康唑乳膏短程治疗。症状积分下降指数（SSRI）≥90％的患者进入长疗程,随机分两组,分别外用曲安奈德益康唑乳膏和润肤霜,间歇用药,共治疗8周。长疗程治疗4周、8周时及长疗程治疗停药12周时各随访1次。结果 长疗程治疗8周及停药12周时,曲安奈德益康唑组SCORAD评分均显著低于润肤霜组（t值分别为3.076和2.367,P值均 < 0.05）。长疗程治疗4周、8周及停药12周时,曲安奈德益康唑组复发率均显著低于润肤霜组（χ2值分别为4.426、7.683、8.199,P值均 < 0.05）。治疗期间不良反应发生率3.1％,无严重不良事件。结论外用糖皮质激素长疗程间歇治疗慢性湿疹,有防止症状加重、延缓湿疹复发的作用。     

Therapeutic approaches to subcutaneous mycoses

Subcutaneous mycoses, which are much less common than superficial fungal infections, are characterized by a heterogeneous group of infections that often result from direct penetration of the fungus into the dermis and subcutaneous tissue through traumatic injury. The fungus spreads by local deep tissue invasion from the inoculation site. The disease usually remains localized and then slowly spreads to adjacent tissue and eventually to the lymphatics. More rarely, hematogenous dissemination is observed. There are usually various clinical features and thus a broad range of differential diagnoses. The common subcutaneous mycoses are sporotrichosis, chromoblastomycosis, phaeohyphomycosis, eumycotic mycetoma, and hyalohyphomycosis. Many subcutaneous mycoses are confined to the tropical and subtropical regions, but some, such as sporotrichosis, are also prevalent in temperate regions. Subcutaneous mycoses can occur in healthy individuals. In immunocompromised individuals, these infections can disseminate widely. Treatment usually involves use of antifungal agents and/or surgical excision. Treatment of some serious subcutaneous mycoses remains unresolved, and there have been reports of relapses or progression during therapy and problems with lack of tolerability of antifungal drugs. Identification of the etiologic agent by culture is essential for prognostic and management considerations, since some fungi are more frequently associated with dissemination. Results of antifungal susceptibility tests may provide valuable information for deciding the appropriate method of treatment. Development of new antifungal agents and combination therapies may result in improvement in the management of subcutaneous mycoses in the future.     

曲安奈德益康唑乳膏治疗脂溢性皮炎78例临床观察

目的观察曲安奈德益康唑乳膏治疗微生物相关皮肤病脂溢性皮炎的临床疗效及安全性。方法治疗组78例脂益性皮炎患者，予早、晚各1次外用曲安奈德益康唑乳膏，并轻揉搓片刻，疗程4周。对照组80例予外搽皮炎平，用药方法及疗程同前。每周复诊时观察皮损情况。结果治疗组有效率89．3％，对照组为66．6％；治疗组出现不良反应3例，占3．8％，均予对症处理，与对照组（8例）比较差异有统计学意义（P〈0．05）。结论曲安奈德益康唑乳膏治疗脂溢性皮炎疗效确切，不良反应少。